Dr Tan Hiang Khoon wears many hats at SGH and SingHealth. He helms a wide and diverse range of institutions and programmes—urgent and large-scale operational tasks like the setting up of Community Care Facilities for COVID-19 patients; the steering of international discussions by medical professionals on the impact of the pandemic on the delivery of surgical care; championing the sharing of Singapore’s healthcare expertise with our ASEAN neighbours.
There’s also his work as a surgeon, meeting cancer patients and their caregivers to provide counsel about treatment and care options. The breadth and diversity of Dr Tan’s professional engagements suggests someone who is able to lead several lives with the resources of one body.
When asked, ‘How do you manage your time?’ Dr Tan answers: ‘Badly!’ He adds with a laugh: ‘Okay, end of interview.’ Then he looks thoughtful and says, ‘I’m very grateful for the love and support of my family, especially my wife Kaia. It’s always been a fine line, striking a b alance between work and family life.’
Dr Tan’s introspection come across not only in his air of unshakeable purpose, but also in his reminiscences about the events that led to his choice of career, his passion for philanthropy and other key decisions. When he casts his mind back upon the past, his manner is relaxed and composed, but there are also flickers of emotion on his face and at times, his voice seems to quiver.
The most formative experience happened when he was 14. His father, who had never had any health issues, fainted one day and was sent to Tan Tock Seng Hospital (TTSH). Even though he regained consciousness and seemed to be his usual self, walking, standing and speaking with ease, the doctors had him admitted and scheduled for a CT scan. But the hospital had only one CT scan machine at that time and his appointment for the scan had to be postponed twice as other more urgent trauma cases came in and those patients had to be scanned first. Just one day before his appointment, Dr Tan’s father slipped into a coma.
‘He never recovered. I remember at that time it was a complete shock to the system. We didn’t expect this and in fact, to this day, we don’t know how he died.’
Apart from grief and shock, there was bewilderment: ‘It’s the sense of helplessness, that you weren’t expecting this and then it happened and there was nothing you could do about it. Just nothing. The doctors couldn’t do anything and we couldn’t do anything. I remember thinking that I cannot let this happen to my family again. I felt a very strong sense of self-preservation. I need to ensure that this doesn’t happen to my family or to any family for that matter.’
The experience led not only to his decision to become a doctor. The help that his family received from relatives, friends and charitable organisations in the aftermath made it possible for Dr Tan and his mother and sister to get through those challenging times emotionally and financially. ‘I am grateful to this day for the help rendered by so many and I can only hope to pay forward what I have received, hence my passion for helping those in need through philanthropy.’
His reflection reveals the motivating force of his compassion and strength of character, a mind that is able to reflect on adversity, take a step back to decide on the necessary actions that can be done to the best of his ability to prevent such things from happening again.
‘The guiding principle for me has always been: is there a clear and present need and does it resonate with me? Am I able to deliver? For me, it’s always been very important that I must feel the compelling need [before I get involved]. Because most of these things, they have challenges, and sometimes, you pay the personal price for it. When the chips are down, you need to k now that you’re doing it for the right reason and for the right cause.’
That childhood tragedy is also the well-spring of his empathetic approach towards patients and their families. He shares openly:
‘I often can relate to patients and how they feel. Perhaps by nature, I find it relatively easy to identify with somebody else’s problems and difficulties and being empathetic about their challenges. But I do think that what my family went through has influenced how I t alk to p atients and engage with their family members.’
Dr Tan’s sub-specialty is in Head and Neck Surgery. He has treated many patients over the years, but to this day, he remembers the patients under his care during his first houseman posting in Paediatrics at TTSH. The plight of one particular patient sparked his decision to s tart the Children’s Cancer Foundation:
‘We had a 14-year-old leukaemia patient who was very challenging to manage. She can come across as moody and would kick you if you tried to give her an injection or take blood from her.’ He had noticed that she was alone most of the time, sometimes going without visitors for days at a time. This was unusual in the children’s ward.
He also knew that the patient’s mother had two other children from her second marriage to the patient’s stepfather. Then an incident allowed him to get to know the patient better: ‘One time, I saw the patient looking out of the window of the Isolation Room at another kid who was just outside, playing the electronic game Tetris. I went to that kid and asked if I could borrow the game for three days. He said okay, I took the game and passed it to the girl.
During those three days, her behaviour changed completely. She accepted help and was cooperative with treatment. After the third day, she gave the game back to me. She continued to be friendly with the medical team but sadly, she passed away a month or two later.’
Dr Tan says that the encounter left a profound impression on him: ‘At first glance, I thought she was a difficult and rebellious kid. But, if you knew about her family and medical history, you could see she was in an extremely difficult situation. She showed us how a simple act of caring can make a big impact.’
The girl’s plight also resonated with him because her death could have been prevented. ‘Lack of awareness and support were contributing factors,’ Dr Tan says, his voice tinged with sadness. He explains that the girl’s life could have been saved if her mother had consented to let one of the girl’s stepbrothers, whose bone marrow was a match, to be a donor:
‘If someone had counselled the mother and stepfather better, or provided more support, they might have changed their mind. And, if the patient had had more support, even if treatment had failed her, her life would have been far less miserable than what it was in the last few months of her life.’
The experience taught him that ‘there’s a lot about Medicine that’s not just about the doctor treating the disease’: ‘It’s about the whole eco-system—the family, caregivers, society. So much more could be done to create awareness and generate support. So in 1991, together with some friends, I started WALK, Working in Aid of Leukaemia Kids. Five years later, we changed it to Children’s Cancer Foundation to have a broader mission.’
His association with the foundation has ended, he says, but he is heartened by how it continues to be a very strong charity. Undoubtedly, the same desire to make a difference to the lives of the less fortunate continues to be a major driver in his work as Director of the SingHealth Duke-NUS Global Health Institute (SDGHI). The objective of the SDGHI is to address healthcare inequalities in ASEAN and beyond. Dr Tan shares that his passion to contribute in this area can be traced back to an incident many years ago when he was a young consultant surgeon. He had gone to Ambon in Indonesia to give a talk. During a hospital round, he saw a patient whom he mistook for a 12-year-old: ‘In fact, he was 22. But he was malnourished, s o small and emaciated I thought he was 12. One look at him and I knew he wasn’t going to survive. He had Cheyne-Stokes breathing, an intermittent irregular breathing seen in patients towards the end of life. I was told that he’d been a normal boy until he was 11 and his parents noticed he had difficulty swallowing. It started with solid food before it progressed to fluids and then he couldn’t eat most things.
My immediate thought was that he had cancer. As the tumour grows, you can’t swallow. But it was unusual that he had been suffering like this for 11 years. So I asked for the imaging and saw the CT scan.
There was a benign tumour that originated from the base of the skull and had grown so large that it obstructed his food passage. It was the sort of problem that would have been easily solved if you were in Singapore.
If only they had had access to appropriate surgical care, that man wouldn’t have had to waste away for 11 years, his parents wouldn’t have had to nurse him all those years.’
Dr Tan takes a sip from his mug of milky tea. On a nearby wall, there is a painting of a local kampong scene. He smiles when he is asked about it. The artist, Mdm Lim Siew Yong, is a patient of his. She is known for her child-like depictions of Peking opera and kampong life, like the painting in Dr Tan’s office. Her art has been featured on stamps and in fundraising efforts for the President’s Challenge.
10 years ago, she was diagnosed with muscular dystrophy. Dr Tan’s first meeting with her took place after a friend asked him to visit her at another hospital where she had been admitted for a tracheostomy. Subsequently, she asked to come to SGH for her follow-up: ‘It’s actually not my area of work. I’m a head and neck surgeon, I deal with cancer. But I suppose I established a certain rapport and relationship with her and she asked me to be her doctor, to maintain the tracheostomy.’
The importance of rapport with patients and their families and caregivers is something that comes up repeatedly during this interview—rapport built on a bedrock of trust. Dr Tan says that he always makes it a point to spend time developing rapport with patients and their families: ‘Head and neck surgery deals with cancer in the oral cavity, in the face, in the salivary glands, in the throat. It involves removing organs that have got very important functions—speech, swallowing, breathing. There is also the aspect of social frontage, the aesthetic part of it. The impact to the patient is immense. Despite the best of our efforts, things may not go well, and that is when the rapport between patient and doctor is critical. For the same reason, you need the support of the family members.’
For someone who jokes that he isn’t good at time management, what he says about always taking the time to connect with his patients and their caregivers seems to offer evidence to the contrary. Empathy for others was embedded in the promise he made to his 14-year-old self. Listening to him today, it is abundantly clear that Dr Tan has done his best to keep that promise.
Dr Tan Hiang Khoon is the Director of the SingHealth Duke-NUS Global Health Institute and the Group Director of the International Collaboration Office. He is also the Academic Chair of the Surgery Academic Clinical Programme and Chairman of the Division of Surgery and Surgical Oncology at SGH and National Cancer Centre Singapore. He has implemented international benchmarking of surgical outcomes through the National Surgical Quality Improvement Programme and established the Global Surgery Programme as one of the signature programmes of Surgery ACP. A well-respected clinician leader who excels in change management, Hiang Khoon was instrumental in the formation of the SingHealth Duke-NUS Disease Centres and the unification of Surgery and Surgical Oncology as a Division. Most recently, he was in charge of the setup and operations of Community Care Facilities in Singapore’s fight against the COVID-19 pandemic.
